title: Real-life effectiveness of statins in the prevention of first acute coronary syndrome in France: a prospective observational study.
abstract: BACKGROUND
  Evidence on the real effectiveness of statins on acute coronary syndrome (ACS) incidence is scarce. We assessed the effectiveness of real-life statins on the risk of first non-fatal ACS in a low-cardiovascular-risk country.
  
  
  METHODS
  Systematic case-control study was conducted in 60 cardiology centres and 371 general practices from across France. A total of 2238 cases with first ACS within 1 month from recruitment and 2238 controls without history of ACS were included; controls were matched to ACS cases on sex, age, frequency of visits to GPs, date of recruitment and personal history of chronic diseases. Statin exposure and risk factors were documented through patient telephone interviews and validated against medical records. The index date was the date of ACS for cases. Adjusted odds ratios (OR) of first ACS and statin use were estimated by multiple conditional logistic regression models controlled for risk factors and propensity score for statin exposure.
  
  
  RESULTS
  Statin use was associated with lower ACS risk, with an adjusted matched OR of 0.67; 95% confidence interval (CI): 0.56 to 0.79 for current use (within 2 months) and 0.73; 95% CI: 0.62 to 0.86 for any use within 24 months [atorvastatin: 0.83 (0.63-1.10), fluvastatin: 0.75 (0.43-1.30), pravastatin: 0.98 (0.72-1.34), rosuvastatin: 0.49 (0.35-0.68) and simvastatin: 0.62 (0.46-0.84)]. The preventive effect of statins on non-fatal ACS reached its maximum after one to four years of use.
  
  
  CONCLUSIONS
  A similar magnitude of effect for statin use was observed in real life, as compared to randomised clinical trials in France.
authors.affiliation: LA-SER, France; Conservatoire national des arts et métiers, France; Equipe d'accueil Pharmacoépidémiologie et Maladies Infectieuses, Pasteur Institute, France. Electronic address: Lamiae.Grimaldi@la-ser.com.
authors.forename: Lamiae
authors.initials: L
authors.lastname: Grimaldi-Bensouda
authors.forename: Michel
authors.initials: M
authors.lastname: Rossignol
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
authors.forename: Jean
authors.initials: J
authors.lastname: Dallongeville
authors.forename: Eric
authors.initials: E
authors.lastname: Bruckert
authors.forename: Jonathan
authors.initials: J
authors.lastname: Banayan
authors.forename: Yves
authors.initials: Y
authors.lastname: Cottin
authors.forename: Elodie
authors.initials: E
authors.lastname: Aubrun
authors.forename: Artak
authors.initials: A
authors.lastname: Khachatryan
authors.forename: Jacques
authors.initials: J
authors.lastname: Bénichou
authors.forename: Lucien
authors.initials: L
authors.lastname: Abenhaim
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D016022:Case-Control Studies; D005602:France / Q000453:epidemiology; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Acute coronary syndrome; Case–control study; Effectiveness; Epidemiology; Real life; Statins